Florida Medicaid Update April 2015 Susannah Cowart, Florida Division Director HomeTown Health

1. Florida Medicaid UpdateApril 2015Susannah Cowart,Florida Division DirectorHomeTown Health

2. APRIL AHCA UPDATES • Amendment to CMS for the 1115 Managed Medical Assistance (MMA) Waiver • Modifications to Meaningful Use for 2015 through 2017; New NPRM Outlines Proposed EHR Requirements for Providers • AllAgency Disclosure of Provider/Recipient Information • CSG Government Solutions Selected for Florida MMIS Research and Planning Procurement Project • CMS Updates; ICD-10 Training and April Impact Assessment Survey

3. 1. Amendment to CMS for the 1115 Managed Medical Assistance (MMA) Waiver “The Agency is also planning to submit an amendment to CMS for the 1115 Managed Medical Assistance (MMA) Waiver.  Under our current system, new Medicaid recipients have to wait from 30 to 60 days before they can enroll in a health plan. The proposed amendment will allow individuals to be enrolled in a managed care plan immediately after they gain Medicaid eligibility. This change means recipients will have access to these benefits as soon as possible. We are requesting an effective date of September 1, 2015.” -Elizabeth Dudek

4. Spring 2015 Bulletin

5. 2. Modifications to Meaningful Use for 2015 through 2017 • On April 10, 2015, Together with the proposedStage 3 notice of proposed rulemaking (NPRM)issued on March 20, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. • Simplifying and Streamlining The proposed rule would streamline reporting requirements. To accomplish these goals, the NPRM proposes:   • Reducing the overall number of objectives to focus on advanced use of EHRs; modifying patient action measures in Stage 2 objectives related to patient engagement • Removing measures that have become redundant, duplicative or have reached wide-spread adoption; • Realigning the reporting period beginning in 2015, so eligible hospitals and CAHs would participate on the calendar year instead of the fiscal year; and • Allowing a 90 day reporting period in 2015 to accommodate the implementation of these proposed changes in 2015.

6. Stage 3 NPRM Comment Period Now Open: Submit by May 29 http://www.regulations.gov/#!home

7. 3. AllAgency Disclosure of Provider/Recipient Information • In accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, Agency representatives are not allowed to disclose provider claim or other information, including recipient protected health information (PHI) to individuals who are not authorized representatives of a Medicaid provider. Authorized representatives include the provider’s employees and any registered billing agents with a Medicaid provider ID (provider type 99). • To receive provider information, the billing agent must also be associated with the provider’s file through the submission of an Electronic Data Interchange (EDI) agreement. Providers may not use an unrelated third-party who is not enrolled in Medicaid as a billing agent. Please contact Medicaid Provider Enrollment at 1 (800) 289-7799, option 4, for information on enrolling as a Medicaid billing agent, or linking to a provider file as a trading partner. • Agency representatives will not disclose any provider information to parties who do not meet the criteria described above.

8. 4. CSG Government Solutions Selected for Florida MMIS Research and Planning Procurement Project CSG Government Solutions, a national leader in government program modernization, announced in January 2015 that it has been selected by the Florida Agency for Health Care Administration (AHCA) to provide strategy, planning, and procurement services for their Medicaid Management Information System (MMIS) and Decision Support System (DSS) Research and Planning Procurement project. “CSG is proud to serve as a trusted adviser to the State of Florida,” says Andrea Danes, Director of CSG’s Healthcare and Human Services practice. “We will help the State navigate the complex healthcare landscape and reach their goal of a statewide integrated delivery system.”

9. 5. Centers for Medicare & Medicaid Services • Fact Sheet: Moving Medicare Advantage and Part D Forward • CMS ICD-10 Provider Resources

10. ICD-10 Training and April Impact Assessment Survey • The April “Preparing for ICD-10 Webinar” is full. The session will focus on explaining billing changes and the impact of the ICD-10 transition. It will be approximately 1 hour in lengthRegisterfor the next webinar that will be held on May 21, 2015 Thursday at 10:30AM - 11:30AM EST • Registration for Area-Specific ICD-10 Training • ICD-10 April Impact Assessment Survey: To continue with preparation for the nationwide ICD-10 implementation date of 10/01/2015 and to measure the amount of progress that has been made, the Agency for Health Care Administration, along with its fiscal agent, HP Enterprise Services, invites our provider communities and partners to participate in the survey “Have You Started ICD-10 Impact Assessment?”Survey Here

11. POLL QUESTION#1 • YES • NO • NOT SURE

12. STAYWELL UPDATES • Provider Newsletter covering topics such as: • EPSDT Requirements for Florida MMA • Q1 2015 Provider Formulary Update • Change in Review Process For Medicare Admissions Effective February 2, 2015 • Availability of Review Criteria • New Claim Edits for 2015 https://florida.wellcare.com/provider/default

13. Wellcare Monthly Provider Webinar • Encounters Overview: • Beginning March 2015- Last Tuesday of every month, 10 a.m.-11 a.m. ET • Navigating the Provider Portal • First session: May 30, 2014, 10 a.m.-11 a.m. ET • Beginning June 30, 2014 - Last Monday of every month, 2 p.m.-3 p.m. ET Webinar/conference access for all webinars:AT&T TeleConference ServicesMeeting Number: 8665905055Passcode: 3729889 https://florida.wellcare.com

14. POLL QUESTION#2 • YES • NO • NOT SURE

15. PRESTIGE UPDATES • Provider Training Schedule • Hospital Orientation Presentation Includes: • Claim Submission Protocol • Provider Portal

16. SUNSHINE HEALTH UPDATES • Spring 2015 Newsletter has not been posted yet • Newsroom • ICD-10 Overview • Claims Processing • Authorization Processing • ICD-10 Implementation and Testing Approach • Transactional-Level Testing • End-to-End Testing • ICD-10 INDUSTRY NEWS AND RESOURCES

17. United Bulletins

18. UNITED APRIL HEALTH BULLETIN Access full Bulletin (via United Healthcare disclaimer)

19. POLL QUESTION#3 • YES • NO • NOT SURE

20. THANK YOU!